Appendiceal torsion presenting as a right lower quadrant mass

The first reported case of primary appendiceal torsion was described by Payne in 1918.1 The description by Payne and subsequent case reports have described clinical scenarios that are largely indistinguishable from appendicitis in most cases.2 Advances in diagnostics and imaging throughout the last century have not led to a marked increase in the diagnosis of this entity either with the diagnosis being made intraoperatively in virtually all cases. Since the time of the first report of appendiceal torsion, reports of this clinical entity remain rare, with approximately 25 reported cases in the English literature and slightly more than half of these in the pediatric literature.2 Speculation remains as to the etiology of the disease process, including anatomic variations such as an elongated mesentery or undescended cecum, strenuous exercise, or as the result of the inflammatory changes that accompany appendicitis.3 Presented here is a pediatric patient presenting with abdominal pain and a right lower quadrant mass seen on imaging that is related to primary appendiceal torsion without underlying neoplasm. At outpatient followup 2 weeks later the patient had returned to her normal activity level and diet and did not appear to have any sequelae. Since the first description of appendiceal torsion in 1918, the diagnosis has remained relatively rare.